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Birth Right

Students and faculty at Johns Hopkins University have devised an ingenious – and very lifelike – simulation that helps doctors deal with birthing room emergencies.
January 6, 2005

Delivering a baby is not simple. But with the help of a new birthing simulator designed at Johns Hopkins University, complicated labors may become easier for doctors, midwives and their patients.

The birthing device consists of four parts, and unlike commercially available birth simulators, the maternal model has a pelvis that mimics soft tissue which allows for better training in matters of maternal manipulation.

The fetal model is equipped with bioengineering instrumentation that allows measurement of the effect of clinician-applied force on the fetus. The custom, nylon-lycra glove has pockets sewn into it to house force-sensors, which are used to measure the traction in delivery. Wires emanating from the sensors are connected to a computer-based data-acquisition system that stores and then processes the data on a laptop.

The goal, as with any simulator, is to better prepare doctors for emergencies that can’t possibly be practiced in real time.

“Complicated deliveries comprise a small percentage of vaginal births, so when confronted in the delivery room with a problem, sometimes doctors arent ready for them” says Dr. Robert H. Allen, an associate research professor in the Department of Biomedical Engineering at Johns Hopkins University.

The simulator began as an idea between Allen and his colleague Dr. Edith Gureswitsch, an assistant professor in obstetrics and gynecology who has been practicing OB/GYN for over 13 years.
Allen assigned his students to come up with a device that would allow doctors and midwives to manipulate a newborn when it was stuck in the birth canal.

The students completed the project last April, 2004. Team leader William Tam and fellow team member Yen Shi “Gillian” Hoe travelled to San Francisco last September when the simulator won top prize in a student design competition during the international meeting of the Institute of Electrical and Electronics Engineers Engineering in Medicine and Biology Society.

It is now being used to study ways to solve complications during high-risk deliveries.

That’s no small task, either. There are around four million deliveries in the United States annually, with about one million delivered via C-section – often because an emergency erupts in the delivery room.

The simulator will help prepare doctors, for instance, for a frightening emergency that can happen with little or no warning such as shoulder dystocia, the obstetric complication where a babys shoulders become stuck behind the maternal pubic bone after the head comes out. That procedure, even when managed correctly, results in 1,500 permanent injuries each year.

And with injured newborns come lawsuits. The American Medical Association estimates that on any given day there are 125,000 lawsuits against doctors. Although most of these cases will be dropped, it costs doctors as much as $90,000 to defend their cases, even if they win the suit.

OB/GYNs are at higher risk for lawsuits in an aggregate sense, because the statute of limitations for bringing a lawsuit is 24 years of age. According to The American College of Obstetricians and Gynecologists, these doctors have an average of 2.6 claims filed against them during their career.

Last year, one in two members of ACOG, which has a membership of 46,000, reported having been involved in a claim in the last four years.

The simulator could reduce the number of injuries in the delivery room, and by extension, reduce the number of lawsuits. But Gurewitsch is quick to point out simply limiting doctor’s liability wasn’t a factor in creating the device.

“Although untoward outcomes are obviously a source for litigation against obstetricians, preventing lawsuits is not our goal,” says Gurewitsch.

Research and training using the simulator continues to take place at Johns Hopkins Hospital. Researchers are working with residents on how to perform one of several maneuvers to manipulate the position of either the mother or the baby when shoulder dystocia occurs.

The Hopkins researchers found that turning the baby so its spine faces the mother’s belly – a technique known as anterior Rubin’s manoeuvre – requires less force than either turning the baby so its spine faces the mother’s spine, or moving the mother’s legs back to try to reduce the force of the baby’s shoulders against the mother’s pelvis.

“If we could prevent even one permanent injury, that would be the wherewithal we would need,” says Allen. ‘Our hope is to have the next generation of (obstetricians) to be more adroit at solving this difficult clinical problem.”

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